Justice is served in two cases

WATCHDOG

The Department of Veterans Affairs finally figured out how to read a calendar. It paid Pauline Green of Lehighton the benefits her husband had been awarded, but not received, before his death.

HealthAmerica, an insurance company under investigation for rejecting emergency room claims, finally figured out what common sense means. It paid for the ER treatment of Linda Sheridan of Palmer Township.

I wrote about Green around Veterans Day. She was fighting for her late husband's accrued veterans benefits.

Howard Green was a career Marine. He served 22 years, including two in the Korean War, where he was wounded and awarded the Purple Heart.

His request for service-connected disability compensation initially was rejected after he mistakenly was classified as ineligible for most benefits, his wife said. The VA had ignored his Purple Heart when considering his eligibility.

By the time that got cleared up, Green was dying. On July 28, the VA finally awarded him benefits, after a year's wait. It printed a check, dated July 30, and mailed it.

Green died Aug. 1 before receiving it.

His widow got it a few days later. She said the VA told her to send it back because it belonged to her husband, not her, despite the fact it had been issued before he died.

She couldn't keep it because he wasn't alive to sign it.

Like a good soldier, Green returned the check. But she appealed the order.

''It was his, yes, but it was issued to him when he was still alive. Therefore, it belongs to his family,'' she argued.

In January, a few months after my column, the VA retreated and paid her. It's not much considering the size of the VA budget, but it's enough to help a widow pay her bills.

''I'm happy with that,'' Green said.

She's not sure what changed the VA's mind, but suspects her persistence and the Watchdog played a role.

''I don't think they liked to read about themselves in the paper,'' Green said.

If the VA had handled things correctly from the start, she wouldn't have had to fight because the benefits check would have arrived sooner, while her husband wasn't on his deathbed.

''He would have been able to sign it, that's for sure,'' Green said.

She believes her husband fought to stay alive because he knew his benefits were imminent. He lived long enough to get the word he'd been approved, just not long enough to collect.

''I swear he hung on until the first. I honestly do,'' Green told me.

Linda Sheridan couldn't hang on anymore, which is why she went to the emergency room at Lehigh Valley Hospital-Muhlenberg in August 2008.

The pain that started on her right side and extended around to her belly button was getting worse after three days.

The hospital ruled out appendicitis. She spent the next three months seeing more doctors and undergoing more tests, leading to a hysterectomy.

In December, I told you how her insurance company, HealthAmerica of Harrisburg, wouldn't cover the $8,200 emergency room bill. It said Sheridan's condition was not an emergency because the pain had started three days sooner, so the trip wasn't ''medically necessary.''

Sheridan didn't know it at the time, but state consumer protection and insurance authorities already were investigating HealthAmerica for denying emergency room claims by using standards higher than those outlined in its insurance plans.

The guidelines call for emergency room treatment to be covered if prudent people believe they need emergency care. In other words, common sense tells them they're in trouble and need immediate aid.

Sheridan wasn't part of that settlement. But I told her about it and she and her husband, Rick, filed their own complaint with the state attorney general's office. I also contacted HealthAmerica on their behalf.

The Sheridans got a letter Jan. 15 from HealthAmerica saying it would pay the claim minus any co-payment or deductible.

''Upon further review of your appeal, information received from the emergency room shows the visit meets the prudent layperson criteria,'' the approval letter said.

Like Green, the Sheridans aren't sure what prompted HealthAmerica's change of heart. HealthAmerica told me it couldn't comment due to customer privacy laws.

But it sent a letter to the attorney general's office saying it had reviewed Linda Sheridan's medical records under its ''revised emergency service review criteria'' stemming from the state investigation.

Because the records showed Sheridan's pain level at the hospital was a ''6 out of 10,'' the claim was approved.

The Watchdog is published Thursdays and Sundays. Contact me by e-mail at watchdog@mcall.com, by phone at 610-841-2364 (ADOG), by fax at 610-820-6693, or by mail at The Morning Call, 101 N. Sixth St., Allentown PA 18101. Follow me on Twitter at mcwatchdog.